Catholic University Of Mozambique

Faculty of Heath Sciences

Public Health I

Epidemiology, Biostatistics and

Preventive Medicine

Beira, 10/06/2019
 Introduction

• Definitions of terms
• Why study Public health
• History of epidemiology
• Preventive medicine

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 Public Health
• Public Health: “Referees to all organized measures
(whether public or private) to prevent disease, promote
health, and prolong life among the population as a
whole”.
Or
• Public health “is the art of applying science in the context
of politics so as to reduce inequalities in health while
ensuring the best health for the greatest number”

• Health “is a state of complete physical, mental and

social well-being and not merely the absence of disease
or infirmity”.
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 Public Health
As a multidisciplinary field, public health:
• Promote the health of population through organized
community efforts

• Protects against threats to health

• Empowers people lives

• Improves the quality of health services

• Prepares leaders to advance health

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 Introduction to Epidemiology

Epidemiology EPI =ON; DEMOS = POPULATION;

LOGOS = STUDY
Epidemiology is the study of:
• the distribution of health outcomes or disease within
populations;

• factors that determine spread of health outcomes and

disease (risk factors)
• the specific populations affected by a health outcome

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 Introduction to Epidemiology (Cont.)
• Epidemiology is a scientific discipline with sound methods of
scientific inquiry through data-driven and relies on a systematic
and unbiased approach to the collection, analysis, and
interpretation of data. (Is the basic science of Public health)

• Epidemiology is concerned with the frequency and pattern of

health events in a population

• Frequency refers not only to the number of health events such

as the number of cases of meningitis or diabetes in a
population, but also to the relationship of that number to the
size of the population. The resulting rate allows epidemiologists
to compare disease occurrence across different populations.
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 Introduction to Epidemiology (Cont.)
• Pattern refers to the occurrence of health-related events by
time, place and person.

• Epidemiology is also used to search for determinants, which

are the causes and other factors that influence the
occurrence of disease and other health-related events
(outcomes)

• Epidemiology is defined as:

The study of the distribution and determinants of the diseases
or health-related event in specified populations, and the
application of this study to control of health problem (CDC,
2012).
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 Introduction to Epidemiology (Cont.)
Evolution of Epidemiology
Time period Events

1850 -1873 Communicable diseases and epidemics

1900 - 1927 Infectious diseases

1927 - 1951 Conditions associated with infectious

diseases
1951 - 1962 Distribution of diseases

1962 - 1988 Control of health problems

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 Introduction to Epidemiology (Cont.)
Epidemiologic transition:

1. Infectious and nutritional diseases linked to agriculture and food

production

Zoonotic diseases and nutrient deficiencies

2. Immune systems and disease-causing organisms

changed; Shift from major epidemics to endemic disease

Humans developed genetic changes

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 Introduction to Epidemiology (Cont.)

Epidemiologic transition:

3. Change to chronic and degenerative diseases; Nutrition, public health,

clinical medicine

Longer lifespan, sedentary lifestyle

4. End of 20th century, New diseases; Re-emergence of

infectious diseases

Rapid spread through globalization

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 Introduction to Epidemiology (Cont.)
4 Epidemiologic Transitions
Transition Resulting Change
1 Hunter-gatherer to cities From few epidemics to major
epidemics
2 Immunologic resistance From major epidemics to
& organism change endemic diseases
3 Public health & sanitation From infectious to non-
infection
4 Increased Globalization Resurgence of infectious
diseases

Fifth Phase of the Epidemiologic Transition: The Age of Obesity and Inactivity
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Introduction to Epidemiology (Cont.)
Pioneers of Epidemiology

Hippocrates (c. 460-377 BCE)

• Environmental and behavioral issues

associated with disease

• Rational explanations for disease

• Disease affects populations

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 Introduction to Epidemiology (Cont.)
Pioneers of Epidemiology

Girolamo Fracastoro (c. 1478-1553)

• Identified ways infections can be

transmitted –direct contact, air,
clothing

• Disease caused by rapidly

multiplying seed

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Introduction to Epidemiology (Cont.)
Pioneers of Epidemiology

Captain John Graunt (c. 1620-

1674)

• Population and mortality statistics

survivorship chart

• Modern demography

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Introduction to Epidemiology (Cont.)
Pioneers of Epidemiology

James Lind (c. 1716-1794)

• Benefit to the field of preventive

medicine

• Improved nutrition

• Helped lead to modern day clinical trials

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Introduction to Epidemiology (Cont.)
Pioneers of Epidemiology

Percivall Pott (c. 1714-1788)

• Association between soot and scrotal cancer

• Environmental factor noted as cancer-causing

for first time

• Beginning of modern non-infectious disease

epidemiology the study of outcomes in
population.
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Introduction to Epidemiology (Cont.)
Pioneers of Epidemiology
William Far (c. 1807-1883)
• Used statistical data to test social hypotheses

• Classified causes of death

• Relationship: population density and mortality
rates

• Mapped deaths, monitored outbreaks,

developed categorization system

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Introduction to Epidemiology (Cont.)

Pioneers of Epidemiology

Sir Edwin Chadwick (c. 1800-1890)

• Proposed public health and social

reform

• Proposed clean water, water closets

and sewer systems

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Introduction to Epidemiology (Cont.)
Pioneers of Epidemiology

John Snow (c. 1813-1858)

• First person to count and map cases

geographically

• Cholera spread by water

• Beginning of epidemiology

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 Uses of Epidemiology
Epidemiology is used to develop, target and evaluate
prevention strategies.
Primary prevention: before the person gets the health
outcome (disease) . Example Vaccines.

Secondary prevention: after health outcome (or disease),

but before symptoms. Example checking for suspicious skin
growths

Tertiary prevention: The symptoms of the diseases (or

health outcome) are already present. Example: dietary
advice to manage diabetes or salt reduce to control
Hypertension
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 Uses of Epidemiology (cont.)

• Epidemiology is also used to evaluate

intervention in the population.
Individual intervention through changing
individual behavior or risk factor. Ex. Educating
individuals on the quitting smoking.

Structural through promote health by altering

structural context. Ex: taxation of tobacco
products.

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 Example of research area using
epidemiology
• Infectious disease/health • Health policy
outcome
• Health behavior
• Etiology
• Chronic disease/health
• Outbreak investigation
outcome
• Disease surveillance
• Maternal/child health • Screening
• Injury and accidents • Bio-monitoring
• Environmental • Molecular
• Occupational • Comparisons of treatment
• Nutrition effects
• Pharmacy/Medicine
• Social

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 Core epidemiology functions

• Public health surveillance,

• Field investigation,
• Analytic studies,
• Evaluation, and linkages
• Policy development

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 Core epidemiology functions (cont.)

Public health surveillance

• Public health surveillance is the ongoing, systematic
collection, analysis, interpretation, and dissemination of
health data to help guide public health decision making
and action.

• The purpose of public health surveillance “information

for action,” is to portray the ongoing patterns of
disease occurrence and disease potential so that
investigation, control, and prevention measures can be
applied efficiently and effectively.
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 Core epidemiology functions (cont.)
• Morbidity and mortality reports are
common sources of surveillance
data for local and state health
departments.

• The reports generally are

submitted by health-care providers,
infection control practitioners, or
laboratories that are required to
notify the health department of any
patient with a reportable disease
such as pertussis, meningococcal
meningitis, or AIDS

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 Core epidemiology functions (cont.)

Field investigation
• Field investigation requiring the coordinated
efforts of dozens of people to characterize the
extent of an epidemic and to identify its cause.

• The propose is to identify the additional

unreported or unrecognized ill persons who
might otherwise continue to spread infection to
others

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Core epidemiology functions (cont.)
Analytic studies
• Analytic studies evaluating the credibility of possible
hypotheses started through surveillance and field
investigations.

Linkages
The epidemiologists need to maintain relationships
with staff of other agencies and institutions through
official memoranda of understanding, sharing of
published or on-line information for public health
audiences and outside partners, and informal
networking
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that takes place at professional meetings 27
 Core epidemiology functions (cont.)

Policy development
Epidemiologists working in public health regularly
provide input, testimony, and recommendations
regarding disease control strategies, reportable
disease regulations, and health-care policy.

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 The Epidemiologic Approach

• As with all scientific endeavors, the practice of

epidemiology relies on a systematic approach to:
• Counts cases or health events, and describes
them in terms of time, place, and person;

• Divides the number of cases by an appropriate

denominator to calculate rates;

• Compares these rates over time or for different

groups of people.
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• Quetions?????

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